Provider Demographics
NPI:1407966344
Name:PROSTHETICS AND ORTHOTICS OF THE OZARKS, INC
Entity Type:Organization
Organization Name:PROSTHETICS AND ORTHOTICS OF THE OZARKS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:CP,CPED
Authorized Official - Phone:417-725-7539
Mailing Address - Street 1:1269 N ROBIN ST
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8097
Mailing Address - Country:US
Mailing Address - Phone:417-725-7539
Mailing Address - Fax:417-725-4290
Practice Address - Street 1:1269 N ROBIN ST
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8097
Practice Address - Country:US
Practice Address - Phone:417-725-7539
Practice Address - Fax:417-725-4290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5645010001Medicare NSC